122P - Concomitant chemo-radiation to 60 Gy followed by surgery for locally advanced non-small cell lung cancer patients; evaluation of trimodality strategy

Date 15 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Poster lunch
Topics Anti-Cancer Agents & Biologic Therapy
Non-Small-Cell Lung Cancer, Locally Advanced
Surgery and/or Radiotherapy of Cancer
Presenter Sarit Appel
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors S. Appel1, Y.R. Lawrence1, J. Bar2, A. Ben Nun3
  • 1Radiation Oncology, Chaim Sheba Medical Center, 52621 - Ramat Gan/IL
  • 2Medical Oncology, Chaim Sheba Medical Center, 52621 - Ramat Gan/IL
  • 3Thoracic Surgery, Chaim Sheba Medical Center, 52621 - Ramat Gan/IL

Abstract

Background

When neoadjuvant concomitant chemo-radiation (CCRT) is administrated prior to surgery for locally advanced non-small cell lung cancer (NSCLC), the radiation dose is commonly limited to 45 Gy. Here we present safety and early outcome data, for patients treated with neoadjuvant CCRT to higher radiation doses.

Methods

We included patients that were treated with CCRT to at least 50 Gy followed by completion surgery in Chaim Sheba Medical Center between August 2012 to October 2015. Platinum-based doublet chemotherapy was administrated concomitantly; radiation therapy volumes were defined with the assistance of co-registered PET/CT images, and did not include uninvolved nodal regions. Patients were selected for surgery according to the extent of mediastinal disease and cardio-pulmonary function at multidisciplinary tumor board meetings. Pathologic response was graded as complete response (pCR) if no viable tumor cells were found in the pathologic specimen or major tumor regression (MTR) if less than 10% viable tumor cells were estimated. Toxicity graded as CTC v 4.03.

Results

The cohort comprised 39 patients. Adenocarcinoma comprised 59% of cases (23/39); 69% (27/39) were AJCC stage IIIA. Median radiation dose was 60 Gy (range 50–62 Gy). The surgical procedure performed was lobectomy in 69% (27/39), chest wall resection in 15.3% (6/39), and pneumonectomy in 15.3% (6/39). Major surgical complications by 90 days post-operation were: chest wall necrosis 5% (2/39), dyspnea 30% (12/39). There was no case of broncho-pleural fistula, major hemorrhage or post-operative death. MTR was found in 74% (29/39) of patient; pCR was evident in 41% (16/39). With medial follow up of 18 month, median overall survival (OS) has not been reached. Estimated 2 year OS is 82% (95% CI 51–94%). Disease free survival (DFS) at 2 years is 59% (95% 38–74%) with median DFS of 24.6 months. Local control rate at 2 year is 92% (95% CI 71–98%).

Conclusions

For patients with locally advanced NSCLC, radiation to a dose of 60 Gy combined with concurrent platinum-based chemotherapy prior to surgical resection appears to be safe. The majority of patients demonstrate major pathologic regressions, and early survival data are promising.

Clinical trial identification

retrospective

Legal entity responsible for the study

Chaim Sheba Medical Center

Funding

Chaim Sheba Medical Center

Disclosure

All authors have declared no conflicts of interest.